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Living in fear of your child's pain: the parent fear of pain questionnaire
Open accessAbstract
Fear and avoidance have been consistently associated with poor pain-related outcomes in children. In the context of the pediatric pain experience, parent distress and behaviors can be highly influential. This study validated the Parent Fear of Pain Questionnaire (PFOPQ) to assess a parent's fears and avoidance behaviors associated with their child's pain. Using the PFOPQ in conjunction with measures of parent and child pain-related variables, we tested the interpersonal fear-avoidance model (IFAM). The sample comprised 321 parents and their child with chronic or new-onset pain who presented to a multidisciplinary outpatient pain clinic. An exploratory factor analysis yielded a 4-factor structure for the PFOPQ consisting of Fear of Pain, Fear of Movement, Fear of School, and Avoidance. As hypothesized, Fear of Pain was most closely related to parent pain catastrophizing and child fear of pain, whereas Avoidance was most closely related to parent protective behaviors and child avoidance of activities. In testing the IFAM, parent behavior contributed directly and indirectly to child avoidance, whereas parent fear and catastrophizing contributed indirectly to child avoidance through parent behavior and child fear and catastrophizing, in turn, influencing child functional disability levels. This study provides the first measure of parent pain-related fears and avoidance behaviors and evaluates the theorized IFAM. These results underscore the important influence of parents on child pain-related outcomes and put forth a psychometrically sound measure to assess parent fear and avoidance in the context of their child's pain.
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“In children and adolescents with FSS, this is supported by the findings of several studies, where parents inadvertently may play a role in reinforcement of maladaptive illness behaviours and beliefs [19, 20, 92, 93].”
From Feasibility of group-based acceptance and commitment therapy for adolescents (AHEAD) with multiple functional somatic syndromes: A pilot study (2020) · cites this paper as [92]
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“In addition to the child's fear of pain, parental fears and avoidance behaviors in the context of their child's pain also contribute to the child's fear and disability levels [5,6].”
From Graded exposure treatment for adolescents with chronic pain (GET Living): Protocol for a randomized controlled trial enhanced with single case experimental design (2019) · cites this paper as [6]
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“Conversely, when adolescents actively confront negative beliefs and emotional distress associated with activities that are associated with pain (i.e. exposure) and parents encourage adaptive functioning in the presence of pain, dysfunctional pain-related beliefs are challenged and a gradual return to function occurs [6].”
From Graded exposure treatment for adolescents with chronic pain (GET Living): Protocol for a randomized controlled trial enhanced with single case experimental design (2019) · cites this paper as [6]
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“Conversely, when adolescents actively confront negative beliefs and emotional distress associated with activities that are associated with pain (i.e. exposure) and parents encourage adaptive functioning in the presence of pain, dysfunctional pain-related beliefs are challenged and a gradual return to function occurs [6].”
From Graded exposure treatment for adolescents with chronic pain (GET Living): Protocol for a randomized controlled trial enhanced with single case experimental design (2019) · cites this paper as [6]
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“These findings support the notion that parent distress impacts child functioning [100].”
From Best-evidence for the rehabilitation of chronic pain part 1: Pediatric pain (2019) · cites this paper as [100]
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Metadata
- Authors
- Simons, L. E., Smith, A., Kaczynski, K., & Basch, M.
- Affiliations
- Boston Children's Hospital (US)
- Corresponding author
- Simons, Laura E.
- Venue
- Pain
- Published
- 2015-04
- Volume
- 156
- Issue
- 4
- Pages
- 694-702
- ISSN
- 0304-3959 (ISSN-L)
- PMC
- PMC4366345
- OpenAlex
- W2323831969
- Cited by
- 92
- References
- 36
- Citations by year
- 2026: 5 · 2025: 10 · 2024: 7 · 2023: 4 · 2022: 7 · 2021: 6 · 2020: 17 · 2019: 14 · 2018: 4 · 2017: 4 · 2016: 6 · 2015: 7
- FWCI
- 6.99
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Pain (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (K23HD067202)
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Childhood Cancer Survivors' Quality of Life
- Keywords
- fear-avoidance beliefs, fear-avoidance model, pediatric chronic pain, pain catastrophizing, functional disability, parental distress, psychometric validation, factor structure
- MeSH terms
- Adolescent, Child, Fear, Female, Humans, Interpersonal Relations, Male, Models, Psychological, Pain, Pain Measurement, Parents, Surveys and Questionnaires, Statistics as Topic, Reproducibility of Results, Disabled Children, Children with Disabilities, Catastrophization
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